1. EHR Systems Quality Labelling and Certification Danish Case Morten BRUUN-RASMUSSEN mbr@mediq.dk MEDIQ Belgrade. 22 nd November, 2011

2. AGENDA 1.The Danish Health Care Sector 2.Certification 3.EuroRec Seal 4.Messaging 5.General Practitioner EHR systems 6.Shared Medication Record MEDIQ

3. The Danish Health Care Sector MEDIQ

4. Denmark  Parliamentary democracy and constitutional monarchy  5,5 mill. inhabitants 90,1% Danish 9,9 % other  5 Regions  98 Municipalities  Equal and free access to healthcare MEDIQ

5. Health Care System: Administrative levels Ministry of Interior and Health National Regional Local 5 Regions 98 Municipalities MEDIQ

6. Health Care Providers – 3 sectors Primary Care Responsible for: General health problems including prevention and chronic diseases Hospitals Responsible for: Specialised treatment and intensive care Municipalities Responsible for: Prevention, rehabilitation and social care MEDIQ

7. Certificatation MEDIQ

8. Business Model and Costs 2/12/10 Low Costs High Costs Third Party Certification Self assessment MEDIQ

9. Interoperability (ALT model) MEDIQ Communication Application level Logical level Technical level Semantic interoperability Technical interoperability presentation clinical content model format & storage transmission terminology functionality Clinical Interoperability Continuity and quality presentation clinical content model format & storage transmission terminology functionality Organisational level FUNCTIONAL TECHNICAL

10. EuroRec Seal MEDIQ

11. EuroRec Seal - Guideline Test environment Test scenarios Test data Conformance criteria's Schedule for testing Test log Delivery document MEDIQ Functional testing/certificaion

12. EuroRec Seal MEDIQ

13. Messaging MEDIQ

14. Cross sector communication  National health care network (1992  ) Frequent messages in large volumes Discharge letters, prescriptions, lab. request and results, referrals, consultation notes....  More than 100 profiles (2011)  Vendor systems are tested by MedCom www.medcom.dk MEDIQ Technical testing/certification Functional testing/certification +

15. 5.5 mill. messages per month MEDIQ

16. Test results are published MEDIQ

17. GP systems and ICPC - 2 MEDIQ

18. ICPC  International Classification of Primary Care Has become a standard all over the world  The ICPC contains 17 chapters A General and unspecified B Blood, blood forming organs, lymphatics, spleen D Digestive F Eye H Ear K Circulatory L Musculoskeletal N Neurological P Psychological R Respiratory S Skin T Endocrine, metabolic and nutritional U Urology W Pregnancy, childbirth, family planning X Female genital system and breast Y Male genital system Z Social problems  ICPC 2 is an extended terminology  A Danish ICPC 2 code chart can be downloaded, printed and used by the GP to find an the ICPC code for a symptom/diagnose MEDIQ

19. GP systems in Denmark (June 2011) MEDIQ 16 vendor of GP systems

20. ICPC 2 - requirements MEDIQ  Enable coding of diagnosis in GP systems  A national specification for the implementation of ICPC 2  Agreed with the vendors  Systems must by certified Functional testing/certificaion

21. Conformance levels MEDIQ Test Group TestsTypeConformance level Baisic functionality28O1100% Core functionality21O280% Extented functionality26O340% Advanced functionality26A0%

22. ICPC test results are published MEDIQ Percent of tests passed

23. Shared Medication Record (SMR) MEDIQ

24. SMR: Paradigm shift FROM sending TO sharing MEDIQ

25. What is SMR? Central SMR service Secure Health- care network Service- platform Local EMR/EHR A Service provider of online medication data to share and update - Transport - Security, - Connection Local service consumer that uses online data via a distributed service platform MEDIQ

26. SMR and EHR in Hospitals  Five years work Specification Development Discussions  Mandatory to use Primary care Secondary care All other  Health professionals can be fined if they do not update the SMR  Fully implemented by end 2012 MEDIQ Technical testing/certification Functional testing/certification +

27. SMR on mobile devices MEDIQ

28. Thank you.. MEDIQ Morten BRUUN-RASMUSSEN mbr@mediq.dk